R A B I E S

Group 5 _________________________________________________________________________________________________________

1. What is rabies? (DEFINITION)

Rabies From Latin: rabies, "madness it is a viral disease that causes acute encephalitis (inflammation of the brain) in warm-blooded animals. It is zootonic (i.e., transmitted by animals), most commonly by a bite from an infected animal. For a human, rabies is almost invariably fatal if post exposure prophylaxis is not administered prior to the onset of severe symptoms. The rabies virus infects the central nervous system, ultimately causing disease in the brain and death.

2. What is rabies? (ETIOLOGY)

It is caused by the RABIES VIRUS, a rhabdovirus of the genus Lyssavirus, from the family Rhabdoviridae. The Rabies Virus RV a neurotropic filterable virus present in the saliva of rabid animals. It has a preferrence for nerve tissues. A rhabdovirus of the genus lyssavirus. RHABDO: from Greek rhabdos, "rod LYSSA: Greek frenzy, rage, fury, canine madness

This is a photograph of the virus under electron microscope

3. Incubation period - The interval between exposure to infection and the appearance of the first symptom 1. One week to seven and a half months in dogs. 2. It is usually 2-8 weeks. It may be as short as 4 days or as long as 2 years in human. 3. Incubation period depends upon the following factors: a. Distance of the bite to the brain b. Extensiveness of the bite c. Specie of the animal d. Richness of the nerve supply in the area of the e. Resistance of the host The virus moves along nerve axons passively about 3 millimeters per hour. It is not known how the virus remains viable or where it is located during prolonged incubation period.

Stages of Rabies Infection

Entry into the body INVASION (0 10 days)

Rabies virus

INCUBATI0N PERIOD (20 90 days)

Death

COMA (5 14 days)

PARALYTIC

EXCITEMENT (2 7 days)

4. Signs and Symptoms

How do you know if an animal has rabies? Animals with rabies may act differently from healthy animals. Some signs of rabies in animals are:

 changes in an animals behaviour general sickness (fever, restlessness) problems swallowing increased drooling aggression (biting at inanimate objects, aimless running) Wild animals may move slowly or may act as if they are tame. Some wild animals (foxes, raccoons, and skunks) that normally avoid porcupines, may even try to bite these prickly rodents. A pet that is usually friendly may snap at you or may try to bite.

How do you know if a man has rabies? Aerophobia Hydrophobia Sensory change on or near Delirium Insomnia Fever Convulsions Laryngeal spasm Salivation or foaming of the mouth Sense of apprehension, anxiety, irritability Acute attack: fever, muscle twitching, hyperventilation and excess salivation Headache ssore throat

The usual duration is 2-6 days without medical intervention. Death is often due to convulsion or respiratory paralysis.

5. Prevention
How can I prevent rabies? Vaccinate your dogs and cats against rabies. Keep your pets under supervision.

 Do not handle wild animals. If you see a wild animal or a stray, especially if the animal is acting strangely, call an animal control officer. If you do get bitten by an animal, wash the wound with soap and water for at least 5 minutes. Make sure you tell an adult and call your doctor to see if you need shots. Get your pets spayed or neutered. Pets that are fixed are less likely to leave home, become strays, and make more stray animals. How do I keep my pet from getting rabies? The best way to prevent rabies is to make sure your pets get and stay vaccinated against rabies!! Other ways to prevent rabies in your pets: Walk your dog on a leash. Never let them roam freely where wildlife may be present. Consider keeping your pets indoors. Call animal control to take wild or stray animals away, especially if you see an animal acting strangely. If an animal bites your pet, handle your pet carefully so you do not get bitten. Get a rabies booster vaccination for them. Even if they have had the rabies vaccination, a booster shot will help them fight off the disease better. Get your pets spayed or neutered. Pets that are fixed are less likely to leave home, become strays, and make more stray animals. Make sure your pet gets and wears their rabies vaccination tags. They should also wear a tag with their name and your address and phone number. Keep them in a fenced yard or on a leash.

How can I protect myself from getting rabies?

Never touch unfamiliar or wild animals. Enjoy wild animals from afar. Avoid direct contact with stray animals. Stray cats and dogs may not have been vaccinated against rabies. Never adopt wild animals or bring them into your home. Do not try to nurse sick animals to health. It is common to want to rescue and nurse a hurt wild animal, but that animal may have rabies. Call an animal control person or animal rescue group if you find a sick animal.

 Make sure that your trash cans and pet foods are secured so that they do not attract wild animals.

6. Medical Management
Local wound treatment. Immediately wash wound with soap and water. Treat with antiseptic solutions such as iodine, alcohol and other disinfectants. Antibiotics and anti-tetanus as prescribed by physician. Rabies Specific Treatment. Post-exposure treatment is given to persons who are exposed to the rabies virus. It consists of active immunization (vaccination) and passive immunization (immune globulin administration).

ACTIVE IMMUNIZATION aims to induce the body to develop antibodies and T-cells against rabies up to 3 years. It induces an active immune response in 7-10 days after vaccination, which may persist for one year or more provided primary immunization is completed MEDICAL AGENT: Human Diploid Cell rabies Vaccine (HDCV) PASSIVE IMMUNIZATION aims to provide IMMEDIATE PROTECTION against rabies which should be administered within the first 7 days of active immunization. The effect of the immune globulin is only short term. Rabies antibodies are introduced before it is physiologically possible for the patient to begin producing his own antibodies after vaccination. Some of the RIG is infiltrated around the site and the rest is given intramuscularly. MEDICAL AGENT: Rabies Immune Globulin (RIG) (Additional)TREATMENT POST-EXPOSURE TREATMENT (PET)

A. LOCAL WOUND TREATMENT Wash with soap/detergent and water preferably for 10 mins. Apply alcohol, povidone iodine/ any antiseptic Anti-Tetanus

*Avoid suturing wounds *Dont apply ointment, cream/ wound dressing ANTIMICROBIAL

Amoxicillin Cloxacillin Cefuroxime

*For those instances where theres no obvious signs of infection( Amoxicillin as prophylaxis ) ***Educate the public simple local wound treatment & warn not to use procedures that may further contaminate the wounds 7. Nursing Management RISK FOR INFECTION TRANSMISSION provide patient isolation Hand washing. Wash hands before and after each patient contact and following procedures that offer contamination risk while caring for an individual patient. Hand washing technique is important in reducing transient flora on outer epidermal layers of skin. Wear gloves when handling fluids and other potential contaminated articles. Dispose of every after patient care. Gloves provide effective barrier protection. A contaminated glove becomes a potential vehicle for the transfer of organisms. Practice isolation techniques. To prevent self-contamination and spread of disease. KNOWLEDGE DEFICIT (about the disease, cause of infection and preventive measures) Assess patients and familys level of knowledge on the disease including concepts, beliefs and known treatment. Provide pertinent data about the disease: organism and route of transmission treatment goals and process community resources if necessary allow opportunities for questions and discussions

ALTERED BODY TEMPERATURE: FEVER RELATED TO THE PRESENCE OF INFECTION. Since fever is continuous, provide other modes to reduce discomfort. If patient is still well oriented, Inform the relation of fever to the disease process. The presence of virus in the body Monitor temperature at regular intervals Provide a well-ventilated environment free from drafts and wind.

DEHYDRATION related to refusal to take in fluids secondary to throat spasms and fear of spasmodic attacks. Assess level of dehydration of patient. Maintain other routes of fluid introduction as prescribed by the physician e.g. parenteral routes Moisten parched mouth with cotton or gauze dipped in water but not dripping.

(Additional)NURSING MANAGEMENT OF RABIES PATIENT Once symptoms start, treatment should center on comfort care, using sedation & avoidance of intubation & life support measures once diagnosis is certain

1. MEDICATIONS a. Diazepam b. Midazolam c. Haloperidol + Diphenhydramine 2. SUPPORTIVE CARE Pts w/ confirmed rabies should receive adequate sedation & comfort care in an appropriate medical facility.

a. Once rabies diagnosis has been confirmed, invasive procedures must be avoided b. Provide suitable emotional and physical support c. Discuss & provide important info. to relatives concerning transmission of dse. & indication for PET of contacts d. Honest gentle communication concerning prognosis should be provided to relatives of pt

3. INFECTION CONTROL a. Patient should be admitted in a quiet, draft-free, isolation room b. HLCR workers & relatives in contact w/ pt should wear proper personal protective equipment (gown, gloves, mask, goggles) 4. DISPOSAL OF DEAD BODIy

8. Why do you think rabies remains to be one of the leading cause of mortality in the Philippines?
Rabies has become a public health problem in the country. It is one of the most acutely fatal infections that cause death. Dogs remain the principal source of rabies. Most dogs in the country are askal or asong kalye. Most of them have rabies since they tend to live around the streets and dirty places. They are everywhere thats why there is a high possibility for them to bite huge number of people. Although a great majority of animal bites are non-infected with the rabies virus, animal control and other public health measures are undertaken because of the high case fatality rate for rabies. All warm-blooded animals are at risk for contracting rabies, however, some species are much more resistant than others. Transmission of the virus is almost always through a bite from a rabid animal. There are a variety of different symptoms and once contracted there is no cure, and death is almost always the outcome. The disease is very preventable through vaccination. While relatively rare in humans, the risk of contracting it, and the outcome of the disease make taking precautions with wild animals and vaccination of domestic ones essential. It is hard to make a definite early diagnosis of rabies, and the disease almost always leads to death even when vaccination and medical management are given as soon as the symptoms have set in.

QUESTIONS MOST FREQUENTLY ASKED ABOUT RABIES QUESTION: Is an increase in the incidence of rabies r/t El Nio? ANSWER: No. Rabies both in humans & animals doesnt in any way follow a seasonal pattern. QUESTION: Is it true that a dog which is rabid dies only after it has bitten a person? ANSWER: No. Whether the dog has bitten a person or not, a rabid dog dies within 14 days. QUESTION: Is rabies curable? ANSWER: No. Once signs and symptoms of brain involvement are manifested, the rabies victim dies within 1-3 days. QUESTION: Is rabies preventable? ANSWER: Yes. By administering vaccine & immunoglobulin at the right time to an animal bite victim, rabies can be prevented. QUESTION: If bitten by a stray animal, what should be properly done? ANSWER: A. Immediately wash the bite wound B. Consult physician/ ABTC C. Consult a vet for mgt of biting dog QUESTION: Do we need to kill the dog immediately? ANSWER: No. If the dog is apparently healthy, it should not be killed immediately & should be kept on leash / caged for observation for 14 days. QUESTION: Does a person bitten by a rabid person need to be given AR immunization? ANSWER: Yes, a rabid person can transmit the rabies virus to another person & need to be given AR immunization.

References: http://en.wikipedia.org/wiki/Rabies http://en.wikipedia.org/wiki/Rhabdoviridae http://mbahdukunbagong.blogspot.com/2011/04/rabies.html http://www.scribd.com/doc/27907966/rabies-ppt http://www.laportecounty.org/departments/animal_shelter/rabie_virus.html http://www.slideshare.net/davejaymanriquez/r-a-b-i-e-s-presentation http://www.peteducation.com/article.cfm?c=2+1556&aid=347